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s / The Breast 23 (2014) S1eS6 S3 CBE. Most patient simulators lack complexity, are not shaped and do not feel like real people. In this paper we show the process for developing realistic breast examination simulators. Method: This paper shows the development of a complex, multi-layered breast model. Through the testing of various materials it shows the systematic building of a life-like look and feel model, including the realistic, anatomically correct layering of ribs, soft adipose tissue, nodularity and complex placement of tumors. ĂSaslow D, Hannan J, Osuch J, Alciati M, Baines C, Barton M, Bobo J, Coleman C, Dolan M, Gaumer G, Kopans D, Kutner S, Lane D, Lawson H, Meissner H, Moorman C, Pennypacker H, Pierce P, Sciandra E, Smith R, Coates R. 2004. Clinical Breast Examination: Practical Recommendations for Optimizing Performance and Reporting. CA Cancer Journal for Clinicians 54:327-344. USE OF BLUE DYE IN SENTINEL LYMPH NODE BIOPSY: TIME TO REEVALUATE G.Y.M. Wong, E. Rippy, M. Bochner, R. Ainsworth. Department of Breast, Endocrine and Surgical Oncology, Royal Adelaide Hospital, Adelaide, Australia Background and purpose: Sentinel node biopsy (SNB) using both blue dye and radioisotope is the recommended approach for axillary staging in patients with early breast cancer. SNB is associated with a learning curve and blue dye may have been useful adjunct to radioisotope when SNB was a relatively new technique.1 Blue dye is associated with adverse effects such as hypersensitivity reactions including anaphylaxis, long-term skin discolouration and interference with carbon tracking. The aim of this pilot study was to reevaluate the need for blue dye in SNB. Methods: Consecutive patients with early breast cancer from May 2011 to May 2012 underwent SNB using the standardised combination of 99mTechnetium-labelled radioisotope and patent blue V or 99mTechnetium alone. The primary endpoint was demonstration of at least one lymph node on histology, regardless of pathological status. Results: Eighty five patients underwent 87 SNB procedures. Forty nine procedures were performed using blue dye and radioisotope and 38 procedures with radioisotope alone. Overall sentinel node identification rate was 99%. The mean sentinel lymph nodes removed in the combination technique and radioisotope alone was 2.6 and 1.8 respectively (p1⁄40.002). Sentinel nodes were demonstrated histologically in 98% (48 of 49) patients using the combination technique and 100% (38 of 38) patients using radioisotope alone. There was no significant difference in the proportion of patients with nodal disease in both groups (adjusted OR1⁄4 1.39, 95% CI 0.46 e 4.21, p1⁄40.58). Conclusions: SNB using radioisotope alone appears comparable to the combination technique. The use of blue dye warrants reevaluation in view of increasing surgeon experience and advancements in gamma probe since the advent of SNB. Reference [1] Clarke D, Newcombe RG, Mansel RE, ALMANAC Trialists Group. The learning curve in sentinel node biopsy: the ALMANAC experience. Ann Surg Oncol, 2004 Mar:11(3 Suppl):211S-5S. AUDIT OF FINE NEEDLE ASPIRATION CYTOLOGY OF BREAST VERSUS HISTOPATHOLOGICAL OUTCOME IN A BUSY PUBLIC HOSPITAL SETTING: VALUABLE TOOL OR AN ANACHRONISM? M. Samarin, W. McLeay, S. Birrell, M. Eaton, C. Hoffman, W. Raymond. Flinders University of South Australia, The Department Surgical Pathology (SA Pathology) and Breast Unit, Flinders Surgical Oncology Clinic, Flinders Medical Centre, Bedford Park, South Australia, Australia Background and purpose: Fine needle aspiration (FNA) cytology remains a valuable tool in the initial investigation of breast pathology. The minimally invasive nature of this technique lends itself well to outpatient and inpatient settings. Audit of the clinical outcome is important in determining the reliability of this technique in this era of increasingly invasive biopsy techniques. Methods and results: 439 consecutive FNAs of breast lesions were performed over a 2 year period (Jan 2010 e Dec 2011) and reported by one of four histo/cytopathologists in the Department of Surgical Pathology, Flinders Medical Centre, two of whom have a specialised interest in breast pathology. The FNA diagnoses were correlated with an audit of subsequent histopathology results (core biopsy or surgical excision in 185 patients) or clinical follow up. 00 FNAs (22.8%) yielded a diagnosis of malignancy. There were no false positive FNA diagnoses. The false negative ratewas 0.67% and inadequate rate 15.9%. Complete sensitivity of FNA was 91.28%. Positive and negative predictive rates of the various benign, atypical and suspicious categories will be presented. Conclusion: This audit indicates that FNA remains an accurate tool for the diagnosis of benign and malignant breast disease with a high concordance with the histopathological outcome. CLOSURE OF THE AXILLARY FASCIAL SPACE AVOIDS THE NEED FOR DRAINAGE IN AXILLARY DISSECTION Krishna B. Clough , Elizabeth C. Penington , Eleanore Massey , Pedro Gouveia . L'Institut du Sein, 7 Avenue Bugeaud, 75116 Paris, France; Monash University School of Rural Health, Mercy St, Bendigo, Vic 3550, Australia Background: Axillary drainage is routinely employed after axillary lymphadenectomy to reduce the rate of seroma formation in these patients. This unit adopted a new technique for axillary dissection that allows closure without the use of an axillary drain. Methods: A standard axillary clearance was modified to a single linear incision of the axillary fascia and predominantly blunt dissection of the axillary tissues, followed by watertight closure of the fascia without the use of a drain. Axillary clearances performed using this technique between January 2010 and December 2011, were monitored for the development of seroma. Results: 41 patients underwent axillary dissection using this technique. The mean number of lymph nodes excised per patient was 13.46 (6-15). 2/ 41 (4.88%) patients developed a seroma in the postoperative period. Conclusion: Axillary surgery can be done without axillary drainage when the axillary fascia can be securely closed at the end of the procedure. MRI GUIDED VACUUM ASSISTED BIOPSIES e THE RBWH EXPERIENCE H. Bhardwaj, H. Cliffton, L. Macy, K. Steinke. Royal Brisbane and Women's Hospital, Brisbane, Australia Background: Many breast lesions can usually be detected using mammography and ultrasound given the advancements made in these imaging modalities. However, few lesions can only be demonstrated by magnetic resonance imaging (MRI) and in such cases MRI-guided vacuum |
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